Healthcare Provider Details

I. General information

NPI: 1255166831
Provider Name (Legal Business Name): SHEL M BOLYARD-DOUGLAS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RRCSB DBA ENCOMPASS COMMUNITY SUPPORTS CULPEPER BEHAVIORAL HEALTHCARE, 16240 BENNETT ROAD
CULPEPER VA
22701
US

IV. Provider business mailing address

17316 WATERLOO RD
AMISSVILLE VA
20106-2059
US

V. Phone/Fax

Practice location:
  • Phone: 540-825-5656
  • Fax:
Mailing address:
  • Phone: 804-479-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number904002081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: